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Publication of the Month |May 2019

    Publication of the Month Publication of the Month |May 2019

    Publication of the Month |May 2019

    By: The McGowan Institute For Regenerative Medicine | Category: Publication of the Month, Publication of the Month 2019 | May 29, 2019

    Author: Kokkinos V, Sisterson ND, Wozny TA, Richardson RM

    Title: Association of Closed-Loop Brain Stimulation Neurophysiological Features With Seizure Control Among Patients With Focal Epilepsy

    Summary: IMPORTANCE: A bidirectional brain-computer interface that performs neurostimulation has been shown to improve seizure control in patients with refractory epilepsy, but the therapeutic mechanism is unknown.

    OBJECTIVE: To investigate whether electrographic effects of responsive neurostimulation (RNS), identified in electrocorticographic (ECOG) recordings from the device, are associated with patient outcomes.

    DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of ECOG recordings and accompanying clinical meta-data from 11 consecutive patients with focal epilepsy who were implanted with a neurostimulation system between January 28, 2015, and June 6, 2017, with 22 to 112 weeks of follow-up. Recorded ECOG data were obtained from the manufacturer; additional system-generated meta-data, including recording and detection settings, were collected directly from the manufacturer’s management system using an in-house, custom-built platform. Electrographic seizure patterns were identified in RNS recordings and evaluated in the time-frequency domain, which was locked to the onset of the seizure pattern.

    MAIN OUTCOMES AND MEASURES: Patterns of electrophysiological modulation were identified and then classified according to their latency of onset in relation to triggered stimulation events. Seizure control after RNS implantation was assessed by 3 main variables: mean frequency of seizure occurrence, estimated mean severity of seizures, and mean duration of seizures. Overall seizure outcomes were evaluated by the extended Personal Impact of Epilepsy Scale questionnaires, a patient-reported outcome measure of 3 domains (seizure characteristics, medication adverse effects, and quality of life), with a range of possible scores from 0 to 300 in which lower scores indicate worse status, and the Engel scale, which comprises 4 classes (I-IV) in which lower numbers indicate greater improvement.

    RESULTS: Electrocorticographic data from 11 patients (8 female; mean [range] age, 35 [19-65] years; mean [range] duration of epilepsy, 19 [5-37] years) were analyzed. Two main categories of electrophysiological signatures of stimulation-induced modulation of the seizure network were discovered: direct and indirect effects. Direct effects included ictal inhibition and early frequency modulation but were not associated with improved clinical outcomes (odds ratio [OR], 0.67; 95% CI, 0.06-7.35; P > .99). Only indirect effects-those occurring remote from triggered stimulation-were associated with improved clinical outcomes (OR, infinity; 95% CI, -infinity to infinity; P = .02). These indirect effects included spontaneous ictal inhibition, frequency modulation, fragmentation, and ictal duration modulation.

    CONCLUSIONS AND RELEVANCE: These findings suggest that RNS effectiveness may be explained by long-term, stimulation-induced modulation of seizure network activity rather than by direct effects on each detected seizure.

    Source: JAMA Neurology. 2019 Apr 15. doi: 10.1001/jamaneurol.2019.0658. [Epub ahead of print]

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    A program of the University of Pittsburgh and the University of Pittsburgh Medical Center
    • Home
    • Our People
      • Faculty/Staff Bios
      • Core Faculty Publications
      • Administrative Resources
    • Our Innovations
      • Impact
      • Patent Matrix
      • Featured Innovations
        • Innovation Insights
        • Coulter Programs
        • Expert Exposés
        • Spinout Spotlight
      • Partnerships & Collaborations
        • Industry
        • Academia
        • Within Pitt
      • Contact
    • About Us
      • Welcome
      • Video
      • Statistics
      • Mission Statement
      • What Is Regenerative Medicine?
      • Contact Us
      • Clinical Site
    • Our Research
      • Focus Areas
        • Tissue Engineering and Biomaterials
        • Cellular Therapies
        • Medical Devices and Artificial Organs
        • Clinical Translation
      • Matrix
      • Centers
      • Laboratories
      • Clinical Trials
      • Initiatives
    • Media
      • Current News
      • News Archive
      • Video
      • Podcasts
      • Newsletter
      • Grant of the Month
      • Publication of the Month
      • Media Contact
      • Video Links
    • Professional Development
      • Seminar Series
      • Special Events
      • Student Interest Groups
      • CATER
      • Post-Doctoral Opportunities
      • Career Opportunities
      • Wiegand Summer Internship
      • Admissions
      • Summer School
      • 2020 Scientific Retreat
      • Human Performance Optimization Symposium
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